A novel scoring system for better management of small bowel obstruction.

IF 1.9 3区 医学 Q2 EMERGENCY MEDICINE
Qi-Hong Zhong, Can-Hong Zhan, Wei-Xuan Xu, Yong Cai, Shuai Chen, Hui Wang, Peng-Sheng Tu, Xian-Qiang Chen, Jun-Rong Zhang, Ping Hou
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引用次数: 0

Abstract

Purpose: Due to the lack of a comprehensive evaluation of the prognosis of small bowel obstruction (SBO), recent clinical strategies have remained subjective and controversial. The recognition of pretreatment risk factors and tailored treatment could improve SBO outcomes.

Methods: A series of posttreatment laboratory tests were integrated into a two-step clustering (TSC) analysis. The TSC outcome was determined according to different predictor importance (PI). A risk score (RS) system for the TSC outcome model was constructed by multivariable analysis. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were calculated to assess prediction accuracy.

Results: Of the 355 patients, 66 (18.6%) were sorted into the better prognosis group (BPG), 149 (42.0%) were sorted into the poor prognosis group (PPG), and 140 (39.4%) were sorted into the severe prognosis group (SPG) by TSC analysis. For the TSC outcome, four variables with higher PI were identified, namely, Ca (PI = 1), albumin (PI = 0.62), WBC count (PI = 0.5) and NE% (PI = 0.45). Compared with the SPG, the BPG presented better outcomes after surgery events. The TSC outcome model was efficient in distinguishing the duration of bowel function recovery and hospital stay by Kaplan‒Meier curves. Via multivariate analysis, a RS consisting of four risk factors, namely, constipation duration (OR = 1.002), APTT (OR = 0.923), PT (OR = 1.449) and PCT (OR = 1.540), was identified. The AUC of the RS on the TSC outcome model was 0.719 (95% CI, 0.635-0.804).

Conclusion: A novel TSC outcome model and RS system was constructed to comprehensively reflect the tailored treatment, surgical events and posttreatment recovery for SBO patients.

一种新的评分系统,以更好地管理小肠梗阻。
目的:由于缺乏对小肠梗阻(SBO)预后的全面评估,最近的临床策略仍然是主观的和有争议的。认识到预处理的危险因素和有针对性的治疗可以改善SBO的结果。方法:采用两步聚类(TSC)分析方法对一系列治疗后实验室检测结果进行综合分析。根据不同的预测因子重要性(PI)确定TSC的预后。通过多变量分析,构建TSC结局模型的风险评分(RS)系统。计算受试者工作特征(ROC)曲线和曲线下面积(AUC)来评估预测精度。结果:355例患者中,经TSC分析分为预后较好组(BPG) 66例(18.6%),预后较差组(PPG) 149例(42.0%),重度预后组(SPG) 140例(39.4%)。对于TSC结果,确定了四个具有较高PI的变量,即Ca (PI = 1),白蛋白(PI = 0.62), WBC计数(PI = 0.5)和NE% (PI = 0.45)。与SPG相比,BPG在手术事件后表现出更好的预后。TSC结局模型通过Kaplan-Meier曲线有效区分肠功能恢复时间和住院时间。通过多因素分析,确定便秘持续时间(OR = 1.002)、APTT (OR = 0.923)、PT (OR = 1.449)和PCT (OR = 1.540) 4个危险因素构成的RS。TSC结局模型RS的AUC为0.719 (95% CI, 0.635-0.804)。结论:构建了一种新的TSC预后模型和RS系统,可以全面反映SBO患者的量身定制治疗、手术事件和治疗后恢复情况。
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来源期刊
CiteScore
4.50
自引率
14.30%
发文量
311
审稿时长
3 months
期刊介绍: The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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